Spinal-cord stimulators: A pain-relief alternative to opioids

Lushunya Wallace has severe lower back and leg pain that she can’t explain, and it’s been dogging her for about two years.

The Northeast Side resident has undergone therapy. She has had steroid injections. And she’s used medications. But nothing helped much.

So Wallace decided to try a spinal-cord stimulator. The device, consisting of wires and a battery, controls pain by delivering electrical impulses to the spine or nerves to block pain signals, a form of neuromodulation.

Such stimulators are an alternative to spinal decompression, through which parts of the spine are removed, and spinal fusion, where the spine is restructured with rods and screws, said Dr. Chris Karas, who inserted Wallace’s stimulator on Monday at OhioHealth Grant Medical Center Downtown. They also are an alternative to opioid-based pain medications that often lead to addiction.

“It has been very difficult to treat long-term or lifelong pain in people in medicine, and the method that’s been used for that most recently has been opiates, and we’ve found there have been a lot of unintended consequences,” Karas said.

But the stimulators have become one more available weapon, he said.Wallace was the first patient to receive a new version of a stimulator manufactured by Medtronic.

“This is a drug-free solution,” said Matt Nawrocki, a local therapy consultant for Medtronic. “Pain doctors can get patients off the pain meds or greatly reduce them after surgery. It’s just phenomenal ... especially in Ohio, with the opioid epidemic.”

Karas treats people with nerve, spinal and joint issues and places about 300 stimulators a year in patients. He said the stimulator, which he called a “pacemaker for the spine,” is more commonly being placed before spinal surgeries instead of as a last resort.

“We’re putting it in much more often as the first line — not a salvage operation where we’re saying ‘We’ve tried everything else, let’s just put a stimulator in,’” he said.

During the surgery, which lasted about half an hour, Karas used an x-ray machine to anchor wires along Wallace’s spine through a small incision in her back. He then inserted a silver battery slightly smaller than a key fob in the back of her hip, using a second incision. Recovery takes about 10 days.

The battery can hold two wires, each with eight electrodes, for 16 electrodes in most patients, allowing for thousands of combinations to treat pain where it originates, he said. Once inserted, patients immediately feel the effect.

Karas said the new device has a new user-friendly, wireless interface and battery that will expand the number of people able to use it.

The battery charges fully in about an hour and lasts for up to 10 years. It also has “adaptive stem” technology, allowing it to automatically regulate the strength of the electrical signal based on a person’s body position. If she’s lying down, for instance, it will deliver a weaker strength than if she’s standing upright.

The interface allows a patient to program the battery with a tablet. Previous versions required a medical professional for programming and maintenance, Karas said.

“Now patients can use it on their own,” he said. “This is great because there are so many people we know who can use this device.”

Alternatives to the stimulator are sometimes not useful, Karas said. Patients say therapy, injections and medication are temporary. While they take away some pain or take the edge off, they don’t help in a permanent way, he said.

Before her surgery, Wallace said her pain rated about a seven out of 10 — every day. She was able to do a trial of a stimulator, and it helped, so she decided to go ahead with implant surgery.

Two days after the procedure, her pain was down to a three. She had relief in both her leg and back.

“It’s a whole bunch of difference,” she said. “When I had it out, I had all kinds of pain. Now I don’t feel pain.”